The present study is a one-group interventional study.
The inclusion criteria were all educators affiliated with SUMS who enrolled in the educational intervention based on the e-flipped learning approach, with a minimum education level of a doctorate, willingness to participate, and an informed consent form. All those unwilling to continue their cooperation received similar courses, and those with extended leave of absence during the study were excluded.
This intervention included developing educational content, selecting a strategy, and implementing the intervention as follows:
This e- flipped educational intervention targets medical educators involved in online teaching.
To increase medical educators’ knowledge, attitude, and perceived behaviour about online teaching.
This intervention is based on constructivism, which holds that the learner constructs knowledge by doing and interacting with others , self-directed learning, which emphasizes students’ responsibility for their education , and multimedia learning to promote active and interactive learning through a variety of media such as text, audio, images, animations or videos . Therefore, designing learning environments based on these theories results in an interactive, active, and flexible endeavor considered in our research.
Twenty multimedia content (e.g., brief videos, podcasts, power points) focused on the following topics: concepts and principles of e-learning, how to become an e-teacher, designing technology-enabled learning, online assessment methods and tools, and innovative technology in medical education.
This course was conducted in the following manner by the e-flipped learning method :
First, the participants were assigned the Learning Management System (LMS), read the course content, and completed the pretest, and then the educational materials were opened for them. Before joining the live sessions, participants read asynchronous content or performed learning activities such as dialogue with peers on a group discussion board. The Learners were guided step-by-step using icons embedded in the learning path. Eight three-hour online sessions were held over 8 weeks. First, the instructors provided learning goals, short presentations, and open-ended questions. Participants had small group discussions in eight virtual breakout rooms. The instructors engaged as facilitators, guiding and encouraging individuals to participate. The lecturers reinforced the examples using PowerPoint and educational videos and then summarized the topics.
A forum for asynchronous discussion and a virtual classroom for synchronous interaction was used. Also, a social network was designed as a second method to answer the participants' questions. It involved using a second platform, such as social media, to allow interaction and engagement. The participants were also encouraged to share their experiences and additional resources on the WhatsApp group.
Five e-learning professors and two physicians with 15 years of work experience in this field were responsible for teaching the course. Also, four information technology experts and two content development experts were active as technical and educational support.
These courses were held through LMS over 8 weeks, including 20 asynchronous and eight online synchronous sessions.
Data collection tools
The faculty members' knowledge, attitudes, satisfaction, and perceived behaviours about online education were evaluated at baseline and 1 week after finishing the training sessions. A researcher-made questionnaire was used based on the first to third levels of the Kirkpatrick evaluation model (additional file 1). The questionnaire consists of five parts:
1-Demographic information (age, sex, education, employment status, job duration).
Level 1. Reaction: assessing the participants’ attitude and satisfaction towards online teaching and the training course at the end of the program (41 questions).
Level 2: Knowledge: evaluating knowledge level before and after the course (12 questions).
Level 3: Perceived behaviour: evaluating the participants' performance after the course (14 questions).
The questions were designed based on the five-point Likert scale. In each dimension of the questionnaire, Scores higher than 60% were considered desirable.
Validity and reliability
Ten experts on medical education, e-learning, and educational management were invited to comment on the questionnaire's aesthetics and content validity. The questionnaire's content validity index (CVI) was calculated on the attitude (0.86), the satisfaction (0.95), the knowledge (0.96), and the behavior (0.96) dimensions. Cronbach's alpha confirmed the reliability of the questionnaire on the attitude (0.90), satisfaction (0.94), knowledge (0.95), and perceived behaviour (0.93) dimensions.
SPSS 21 was used to analyze the collected data, including descriptive and analytical statistical tests. A paired t-test was used for comparing pre and posttest knowledge scores. Also, ANOVA and an independent-sample t-test were used to compare the differences across the socio-demographic groups. The Pearson correlation coefficient was used to examine the relationship between the three levels of the questionnaires. A P-value of 0.05 was considered the significance level.
One hundred and eighty faculty members of the Shiraz University of Medical Sciences participating Sciences who enrolled in the e-flipped course were selected by census method from July 2019 to December 2021. Each course lasted 8 weeks and had 20–22 participants.